Understand utilization and reduce healthcare expenses

It is more important than ever to reduce healthcare expenses as a business owner and as a consumer. We should look beyond standard practices and more into how each of us as individuals can shape and alter healthcare outcomes. A simple way to accomplish this is by evaluating current healthcare benefit plans to understand whether opportunities are being realized.

As an employer, maintaining healthcare benefits for employees can be costly and complex. However, as a forward-thinking business leader, there are many opportunities to minimize healthcare costs while still providing employees with quality health insurance.

Encourage use of preventive health services to maintain a healthy workforce: Educating employees about using preventive health services is important when trying to reduce costs. Employee wellness contributes to lower healthcare costs and a healthier, more productive workforce. By encouraging your employees to take advantage of services like annual physical exams, immunizations and age-specific screenings, you begin the process of fostering a healthier, more productive workforce.

Communicate your benefits program simply, effectively and regularly: The best method for keeping your employees engaged in their healthcare is to regularly communicate benefit changes and opportunities. Providing a summary of benefits that outlines coverage will allow employees to understand what their plan includes and what benefits they may not be utilizing. Additional ways to communicate with your employees include adding pertinent information in your company newsletter, sending email reminders about key dates and incorporating benefit information within employee paychecks. These practices will also assist in developing an open forum of communication for employees to voice concerns or provide feedback about the benefits offered. It is also important to note that if you maintain consistent communications with your health plan representatives, you can ensure you have the most current information to share with your employees.

Utilize incentives and expand employee wellness programs: Your workplace can be an ideal outlet to promote healthier lifestyles, and employee wellness programs are one of the easiest ways to maintain a healthy organization. You can also maximize cost savings opportunities by utilizing government incentives like small business tax credits. These incentives allow employers to encourage healthy living by offering programs that address chronic conditions such as tobacco use, obesity, fitness, nutrition and diabetes, among others (learn more at healthcare.gov). The U.S. Department of Health and Human Services has identified five components of implementing a successful workplace wellness program, that include: health education tailored to your employees' interests and needs; support mechanisms that encourage healthy practices; onsite health screenings; programs that support the work and life balance; and integration of wellness policies into your corporate structure. When your employees are encouraged to live healthier, their productivity, morale, health awareness and involvement are all improved.

Customize plan options to give employees greater flexibility: Some organizations have the ability to utilize fixed-contribution benefit plans, which offer members more options and a choice on what benefits best meet their individual and family needs. With this type of plan, employees can take advantage of a fixed-dollar amount contributed toward the purchase of their customized medical plan. This option allows employees to adjust a plan to their specific healthcare needs and maximizes the employer contribution.

What your employees can do: Employees have the greatest opportunity to reduce healthcare spending by understanding how and when to utilize benefits. One of the best times for this to happen is during open enrollment, when members can speak directly with a health plan representative to clarify plan benefits and ask questions. Education will become critical to helping employees become active participants in their healthcare decisions.

Understand the scope of benefits and how to use them effectively: It is imperative that employees not only know what benefits are included within their health plan, but also how to use those benefits to their advantage. First, employees should understand which providers are in- network and what it really means if they access a provider who is out-of-network. A visit to an out-of-network physician may not be necessary and can result in costly out-of-pocket fees. Employees should consult their printed provider manual or access an online version to learn about network providers. Another option for employees to save on out-of-pocket expenses is to use generic prescriptions, which can easily be discussed with a family practice physician or specialist. On average, the cost of a generic drug is $25, while a name brand prescription averages $200. All generic drugs are approved and regulated by the Food and Drug Administration. Lastly, visiting an urgent or retail care facility rather than an emergency room is far less expensive. Although both facilities offer similar healthcare services, it can be costly to use an ER when the condition is minor. By using best practice tips, employees can find alternatives that are less expensive but still offer the same quality care.

Utilize preventive services included within a benefit plan: Employees should be aware of all their health plan options, including no-charge services. Many, if not all, insurance plans offer free services like immunizations, Well Baby visits and exams, and related wellness screenings. Each of these services helps to keep employees and their families healthy. For a full list of no-charge services, employees can refer to their benefits plan or contact their HR representative.

Develop a relationship with an onsite benefit coordinator: An organization's Human Resources department is a vital resource in helping communicate benefit information to employees, and so it is imperative that your employees are encouraged to keep an open and consistent relationship with their onsite benefit coordinator. A benefit coordinator can act as a liaison between the employee and the health insurance company, ensuring that communications are accurate and easy to understand. Your HR department has a wealth of information provided to them directly from the health plan and these resources can be of tremendous value to helping everyone maintain affordable healthcare costs.

Communicate with providers to realize savings opportunities: Many employees do not look to providers as a source to help them save on healthcare costs. However, physicians and specialists are the primary source who refer patients to other facilities, order labs and write prescriptions. If your employees maintain an open line of communication with their personal healthcare provider they can work with them to find alternatives and solutions that meet their budget needs and benefit plans criteria. Researching cost savings and asking additional questions can help them understand their healthcare benefits and keep them engaged in the process of making more informed healthcare decisions.

In closing, as business owners and consumers, we must work hard to improve the future health of our organizations by actively engaging in healthcare decision-making and discussions. It is ideal for all of us to make a continuous investment in the outcomes of our own care. By communicating and educating ourselves about healthcare utilization, we can develop better practices that yield healthier, more productive work places.

Don Kowitz is president and CEO of Saint Mary's Health Plans.